Certificate of Need Laws in New Hampshire — What Patients Need to Know
New Hampshire is one of the states that maintains a full-scope Certificate of Need (CON) program, requiring healthcare providers to obtain state approval before building new facilities, expanding services, or acquiring major medical equipment. First enacted in 1979, the law covers a wide range of healthcare services and is administered by the New Hampshire Department of Health and Human Services — Health Facilities Administration. Understanding how CON laws work in the Granite State can help patients make more informed decisions about the healthcare landscape around them.
NEW HAMPSHIRE — KEY FACTS
| CON Law Status | ACTIVE CON LAW |
| Programme Scope | active |
| Year Enacted | See agency |
| Services Requiring Approval | hospitals, nursing homes, ambulatory surgery centres, imaging equipment (MRI/CT), dialysis facilities, hospice providers, psychiatric facilities, home health agencies |
| Governing Agency | New Hampshire Department of Health and Human Services — Health Facilities Administration |
| Hospitals in State (CMS data) | Data not available |
The Arguments
WHAT SUPPORTERS ARGUE
Defenders of New Hampshire’s CON laws argue that the program helps prevent unnecessary duplication of expensive healthcare services, which could drive up costs for patients across the state. They contend that CON review ensures new facilities and services are placed where community need is greatest, helping to maintain access in rural and underserved areas of New Hampshire. Supporters also assert that the approval process helps preserve the financial stability of existing safety-net providers that serve vulnerable populations.
WHAT CRITICS ARGUE
Critics of New Hampshire’s CON laws argue that the approval process creates barriers to entry for new healthcare providers, reducing competition and potentially keeping prices higher than they would be in a more open market. They contend that incumbent healthcare systems can use the CON process to block competitors, limiting patient choice and innovation. Opponents also point out that the lengthy review process can delay patient access to new services and technologies that communities may urgently need.
The Data
WHAT THE DATA SHOWS IN NEW HAMPSHIRE
The absence of publicly comparable hospital pricing data in this sample makes it difficult to draw direct conclusions about how CON laws affect healthcare costs in the state. Further research using state-level data from the New Hampshire Department of Health and Human Services may provide additional insight into the program’s impact on healthcare pricing and access.
Recent Developments
In 2022, the New Hampshire legislature debated potential reforms to the state’s Certificate of Need program but ultimately chose to maintain the existing framework. The 2022 amendments represent the most recent changes to the law, though the specific details of those amendments reflect an ongoing policy conversation about the appropriate scope of CON regulation. No additional recent news coverage of further legislative action or reform efforts has been identified at this time.
What This Means For Patients in New Hampshire
For patients in New Hampshire, the CON law means that the availability of new healthcare facilities and services is subject to a state review process, which may affect where and when new options become available. Patients may benefit from coordinated healthcare planning in their communities, but they may also experience limited choices in some service areas if new providers face barriers to entering the market.
THE BOTTOM LINE
New Hampshire maintains a full-scope Certificate of Need program that shapes where and how healthcare services expand across the state, with ongoing debate about whether the law best serves patients by ensuring careful planning or whether it limits competition and choice.
Frequently Asked Questions
Does New Hampshire have a Certificate of Need law?
Yes, New Hampshire has had a Certificate of Need law since 1979, and the program remains active with full scope. The law was most recently amended in 2022 and is administered by the New Hampshire Department of Health and Human Services — Health Facilities Administration.
What services require CON approval in New Hampshire?
New Hampshire’s CON law covers a broad range of healthcare services, including hospitals, nursing homes, ambulatory surgery centers, imaging equipment such as MRI and CT scanners, dialysis facilities, hospice providers, psychiatric facilities, and home health agencies. Providers seeking to establish, expand, or significantly alter any of these covered services must obtain CON approval before proceeding.
How do New Hampshire CON laws affect hospital costs?
The effect of CON laws on hospital costs is a matter of ongoing debate, with proponents arguing the program prevents costly duplication of services and critics contending it reduces competition that could otherwise lower prices. No CMS hospital charge data for New Hampshire facilities was available in the dataset reviewed, making direct cost comparisons difficult at this time.
Can I find out if a facility has CON approval in New Hampshire?
Yes, the New Hampshire Department of Health and Human Services — Health Facilities Administration oversees the CON program and maintains records of approved applications. Patients and the public can visit the agency’s website at https://www.dhhs.nh.gov/hfa or contact the agency directly for information about specific facility approvals.